198205024-5-7-2026-11-AS-SCIS-DUAVVQ-20260521164644

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198205024
Report Date: 05/07/2026
Date Signed: 05/07/2026 03:37:58 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/27/2026 and conducted by Evaluator Lizeth Villegas

COMPLAINT CONTROL NUMBER: 11-AS-20260427155940

FACILITY NAME:	HACIENDA GRANDE SENIOR ASSISTED LIVING		FACILITY NUMBER:	198205024
ADMINISTRATOR:	LORENZONA ELVIE MEDINA		FACILITY TYPE:	740
ADDRESS:	1740 GRAND AVENUE		TELEPHONE:	(562) 597-7753
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90804
CAPACITY:	120	CENSUS: 72	DATE:	05/07/2026
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Adminisrator Lorenzona Medina		TIME COMPLETED:	03:36 PM

ALLEGATION(S):

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Staff did not meet the resident's diapering care needs in a timely manner.
Staff did not clean the resident's room in a timely manner.
Residents are not provided meals that consist of an appropriate variety of foods.

INVESTIGATION FINDINGS:

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On 05/07/26 at 9:00 am Licensing Program Analyst (LPA) Villegas conducted an initial complaint visit regarding the allegation(s) above. LPA met with Adminisrator Lorenzona Medina (staff #1 S1) as the purpose of today’s visit was explained.

The investigation consisted of the following: On 05/07/26 LPA Villegas obtained copies of the staff and resident rosters, facility menus for April 2026-May 2026, housekeeping schedule, and a list of incontinence care residents. On 05/07/26 LPA also obtained copies of the following documents for Resident #1-3 (R1-R3) Emergency ID forms, pre-appraisals, admission agreements, Physicians reports, needs and service plan dated: On 05/07/26 from 10:00 am- 11:30am LPA conducted Interviews with R1-R7, and from 11:30am-12pm LPA observed lunch service. On 05/07/26 from 1pm- 2pm LPA conducted interviews with staff #1-5 (S1-S5). On 05/07/26 LPA conducted a review od documents obtained.

The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260427155940

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: HACIENDA GRANDE SENIOR ASSISTED LIVING	FACILITY NUMBER: 198205024
	VISIT DATE: 05/07/2026

NARRATIVE

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Allegation: Staff did not meet the resident's diapering care needs in a timely manner.

It is alleged that facility staff are refusing to change residents diapers as residents can wait up to 4 hours for assistance. On 05/07/26 LPA conducted Interviews with R1-R7 regarding the allegation above. 2 of the 7 residents interviewed denied the allegation above and reported staff have not refused to assist with incontinence care. 5 of the 7 residents interviewed reported that they do not require assistance with incontinence care as they can do it themselves. On 05/07/26 LPA conducted interviews with S1-S5 regarding the allegation above. 4 of the 5 staff interviewed denied the allegation above and reported that residents are provided with incontinence care assistance 2-3 times per shift or as needed. Additionally staff report that rounds/checks are conducted every 2 hours. 1 of the 5 staff interviewed reported having no knowledge of the allegation above as they do not provide direct care to residents. On 05/07/26 LPA conducted a review on documents obtained for R1. Per physicians report dated: 02/27/26, R1 requires diapers and needs assistance with toileting needs. Per R1's appraisal dated: 03/06/25 R1 requires assistance with continence, bowel, and bladder control. Per R1's individual service plan dated: 03/11/26 R1 is occasionally incontinent to both bladder and bowel but usually declines wearing pull ups.

Allegation: Staff did not clean the resident's room in a timely manner.

it is alleged that facility staff complain about the incontinence smell and do not to assist.
On 05/07/26 LPA conducted Interviews with R1-R7 regarding the allegation above. 5 out of the 7 residents interviewed denied the allegation above and reported that their bedrooms are cleaned daily. 1 of the 7 residents interviewed reported being unaware of how often their bedroom is cleaned, 1 of the 7 residents interviewed reported that their bedroom is cleaned once a week. On 05/07/26 LPA conducted interviews with S1-S5 regarding the allegation above. 4 of the 5 staff interviewed denied the allegation above and reported that resident bedrooms are cleaned every day, 1 of the 5 staff interviewed added that 5 bedrooms are deep cleaned daily. 1 of the 5 staff interviewed reported having no knowledge of the allegation above as they do not provide direct care to residents. On 05/07/26 LPA conducted a review of housekeeping schedule, per schedule there are 3-4 staff each day from 6am-4pm who oversee facility cleaning which includes resident bedrooms.

Allegation: Residents are not provided meals that consist of an appropriate variety of foods.

It is alleged that facility is mostly serving Filipino foods which is causing resident in care to have diarrhea

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260427155940

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: HACIENDA GRANDE SENIOR ASSISTED LIVING	FACILITY NUMBER: 198205024
	VISIT DATE: 05/07/2026

NARRATIVE

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often. On 05/07/26 LPA conducted Interviews with R1-R7 regarding the allegation above. 6 out of the 7 residents interviewed denied the allegation above and reported that the meals provided are different everyday. 6 of the 7 residents interviewed reported that they have not gotten sick from the food they are served. On 05/07/26 LPA conducted interviews with S1-S5 regarding the allegation above. 5 of the 5 staff interviewed denied the allegation above and reported that the food served is different every day. On 05/07/26 LPA conducted a review of facility menus dated: 03/30/26- 05/10/26, LPA observed that meals are rotated and are different every day. On 05/07/26 LPA observed lunch service, LPA observed meals served to match the meal listed on the menu. Furthermore LPA observed R1 walk into the dinning room and opted out of lunch service.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted, and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2026

LIC9099 (FAS) - (06/04)

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